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Biomedical subjects

D Tübergen

Publications and source records attributed to D Tübergen.

10 recordsLinked to original sources
PubMed2003

Stent migration necessitating surgical intervention.

BACKGROUND: Internal drainage with transhepatically or endoscopically placed endoprostheses has been used for many years as a temporary or definitive treatment for biliary tract obstruction. As a late complication, stent migration may occur. METHODS: We reviewed our records to identify patients who were operated on for a migrated endoprosthesis that was causing complications. In all, five such patients were identified. RESULTS: One patient had a large bowel perforation. Bowel penetration led to an interenteric fistula in one patient and to a biliocolic fistula formation in another. Small bowel distension was found in two patients. Surgical treatment consisted of local excision in three patients, segmental resection in one patient, and a bypass operation in the patient with biliocolic fistula. Postoperatively, four patients recovered without problems, but one patient died during a complicated postoperative course. CONCLUSION: If a stent becomes stuck in the gastrointestinal tract and is not accessible for endoscopic removal, early operative revision is mandatory to prevent further complications.

Adult↗
PubMed2002

[Rectal carcinoma in a patient with familial adenomatous polyposis coli after colectomy with ileorectal anastomosis and consecutive chemoprevention with sulindac suppositories].

Surgery is the definitive treatment in familial adenomatous polyposis coli (FAP). Proctocolectomy with ileal pouch anal anastomosis is recommended for the majority of FAP patients. Only in patients with attenuated FAP, is a colectomy with ileorectal anastomosis (IRA) accepted, although the risk for rectum carcinoma remains increased. Sulindac, a chemoprophylactic agent, regresses colorectal adenomas in patients with FAP. Under systemic Sulindac-therapy, three carcinomas in the rectum after colectomy with IRA have been described. We report the first known case of rectum carcinoma in a patient with FAP, 51 months after IRA and local Sulindac therapy.

Adenocarcinoma↗
PubMed2002

[Resection of tumor stenoses and stent implantations in advanced neoplasms of the esophagus, stomach and duodenum].

Up to now many people demand treatment only with symptoms of a progressed cancer disease. As curative therapy is often not possible any more, endoscopy offers valuable palliative treatment options. Tumor destructive methods are mainly used for soft exophytic neoplastic tissue, whereas stent implantation is the therapy of choice in all other cases, especially if severe obstruction is present. The advantage of this method is the immediate and long lasting effect. Because of the different stent types and indications there is no optimal universal stent, so that we have to choose the individual best endoprosthesis.

Duodenal Neoplasms↗
PubMed2001

[Management of biliary complications after orthotopic liver transplantation].

In this retrospective analysis we report our results after liver transplantation regarding biliary complications (bc) and the effectiveness of endoscopic therapy. In the last 4 1/2 years we found 13 biliary leaks (7 in combination with a stenosis, 3 at the T tube insertion site), 9 biliary stenosis, 3 papillary stenosis, 2 biliary aggregates and one case of ischemic type biliary lesion, resulting in an overall complication rate of 30%. 10 (36%) "bc" could be treated successfully endoscopically, whereas 8 (32%) patients are still under observation with an endoprosthesis in the biliary tract. 10 endoscopic trials were without the desired effect, requiring a surgical reintervention. In 4 cases a thrombosis of the hepatic artery was responsible for the unwanted course.

Adolescent↗
PubMed2001

[Assessment of drain insertion in thyroid surgery?].

INTRODUCTION: Although generally recommended the benefit of suction drains in thyroid surgery is not proven. METHODS: Therefore, we started a prospective randomized trial including all patients who were referred to our institution for resection of an euthyroid goiter (n = 52 with drains and 48 without). On the third postoperative day as well as four weeks later the patients were questioned and physically examined, including an ultrasound of the neck and, if present, the measurement of a hematoma. RESULTS: Two patients had to be reoperated due to a hemorrhage detected by the drains. Further the study revealed that patients without drains left the hospital significantly earlier (3.9 vs 4.6 days, p = 0.006). On the other hand the hematoma size in this group was larger than in the group with drains (1.9 ml vs. 0.9 ml, p = 0.016). The other clinical parameters were comparable in both groups. Four weeks postoperatively no differences were detected. DISCUSSION: So far neither our results nor those in the literature could prove that severe postoperative hemorrhage can be recognized or treated faster with the use of drains. Although drains reduce the size of hematomas significantly, the quantity is too small for any clinical relevance. Based on these results a general insertion of drains after resection of an euthyroid goiter is not recommended.

Adult↗
PubMed1995

[Diagnostic and therapeutic problems of acute lower gastrointestinal hemorrhage].

In a four year period (1990-93) 75 patients were treated in our hospital for acute lower gastrointestinal bleeding. In the course of diagnostic procedures an upper gastrointestinal bleeding was excluded routinely and further 126 endoscopic measures were performed. All patients underwent rectoscopy and additional partial or total coloscopy. In addition to that, 16 scintigrams and 7 angiograms were taken. The validity of the endoscopic measures was 0.73, scintigraphy and angiography were less valid with 0.53 and 0.34. Therefore endoscopic diagnostic procedures are of more value. 32 of these 75 patients underwent operative treatment. Recurrent bleeding after operative treatment was seen in 6.25%. Overall mortality was 5.33%. Because prognosis of a recurrent bleeding after operative treatment is poor, primary subtotal colectomy is indicated when the source of bleeding can not be localized.

Aged↗
PubMed1994

[After-care in colorectal cancer--data and patient oriented evaluation].

The results and the costs of a routine follow-up program for patients with curatively resected colo-rectal carcinoma were evaluated in a retrospective matched pair study. Patients, who never had participated in such a program, were used as controls. In addition 58 patients were questioned prospectively regarding their opinion about the value of the follow-up program for their present and future life. Significantly more local recurrences and distant metastases were diagnosed at an average of 1.5 years earlier in the follow-up group as compared with the control group. Neither the hereby resulting higher number of curatively resected local recurrences or distal metastases nor a more aggressive oncological approach in unresectable cases resulted in a substantial improvement of survival time in the follow-up group. Considering the relatively high costs of the program, only the diagnosis of several other illnesses which one was able to treat, and the high appreciation by the patients speak in favor of the follow-up program. 86.2% of the patients believed that routine follow-up would be of essential value for their future life.

Aftercare↗
PubMed1993

Electronic photography: a new age of medical imaging?

This is a critical overview of present conceptions of the introduction of electronic photography in medicine. It is not a complete list of products, rather it is a description of how the requirements of the physician have influenced medical illustration in the past and will continue to do so in the future. Video systems are widely used in medicine. Besides the learning and teaching of effects of television, minimal invasive surgery (MIS) has become reality through endoscopy, rapidly accepted worldwide. Documentation of endoscopic procedures and their effects is becoming routine. Therefore, the conversion of complex optical information into binary units is a logical development to save space for storage. The reproduction, storage and transfer of detailed images is already realized by digital camera systems, photo CD, scanners and picture archiving and communicating system (PACS). Now electronic imaging in medicine has to be regarded as a matter of routine. The real impact of accelerated editing will be shown in the future.

Computer Graphics↗
PubMed1987

[Human albumin therapy and prognostic value of determining colloid osmotic pressure at the surgical intensive care station].

367 patients treated on the intensive care unit were prospectively documented during a 1-year observation period. Plasma colloid osmotic pressure (COP) was daily measured. Human albumin therapy was required only in 10% of all patients. These mainly long-term (greater than 10 days) treated patients also showed the lowest levels of COP (minimum COP means: 21 cmH2O (= 15.4 mmHg]. In the majority of all cases an extreme decrease of COP (less than 20 cmH2O (= 14.7 mmHg] was due to sepsis associated with an unfavorable prognosis. 67% of all patients with at least a single decrease of COP less than 20 cmH2O died, as compared to 15% of the patients where the COP never fell below 25 cmH2O. When a low COP was secondary to sepsis, the therapeutic benefit of an albumin therapy could not be evaluated.

Adolescent↗